[THE PREDICTIVE SIGNIFICANCE OF A MALLAMPATI SAMSOON & YOUNG SCORE AT OPERATIONS IN NOSE AND NASOPHARYNX AT CHILDREN].

BACKGROUND: The difficult airways at children happen rarely, but can lead to serious complications. MATERIALS AND METHODS: Results of studying of sensitivity, specificity and predictive importance of a scale of Mallampati at 379 children aged from 3 till 17 years (ASA physical status I-II), who underwent surgery in the nasal cavity and nasopharynx, are presented in this article. Depending on result of Mallampati's score children have been distributed on 2 groups. In the first group 20 children had predictions of the difficult intubation of a trachea, 19 of them had the 3rd degree by Mallampati, 1 child had the 4th degree by Mallampati. In the second group 370 children had 1-2 class on Mallampati scale. During direct laryngoscopy, 8 patients had 3 degree on Cormack & Lehane and the 382 patients had 1-2 degree on Cormack & Lehane. The degree of the laryngoscopy's difficulty determine by results of the Mallampati Samsoon & Young. RESULTS AND CONCLUSION: It is found out that sensitivity (Se) of a scale of Mallampati in modification of Samsoon & Young at children at operations in the nasal cavity and nasopharynx of 50%, specificity (Sp) of 96%, the positive predictive value (+VP) of 20%, the negative predictive value (-VP) of 99%.

[PHARMACOLOGICAL CARDIOPROTECTION DURING REPERFUSION OF ISOLATED HEART].

PURPOSE: To study the contractile function, the degree of damage and regional myocardial metabolism in the isolated rat heart model subjected to cardioplegic stop and reperfusion under the protection of levosimendan. MATERIALS AND METHODS: The study was performed on isolated rat hearts Wistar (group using "Custodiol" vs group using "Custodiol" + "Levosimendan". We assessed the extent of myocardial damage (in terms of markers of myocardial necrosis), the contractile function of the myocardium (coronary flow, heart rate, left ventricular pressure), the dynamics of redox processes during reperfusion with a parallel study of histology of the myocardium. RESULTS: We found a presence of cardioprotective effect of levosimendan in respect of the isolated heart in the reperfusion period of cardioplegic ischemia. The effect related to reducing the emission of reperfusion enzyme markers of myocardial damage, reducing the severity of pathological changes in the myocardium and reducing the intensity of free radical reactions in the myocardium. CONCLUSIONS: Cardioprotection with levosimendan reduces the severity of free radical attack the isolated heart, reduces the severity of damage to cardiomyocytes and preserves the contractile activity of the myocardium during reperfusion due to the effect of postconditioning.

[PERIOPERATIVE CARE FOR PATIENTS WITH UNDERLYING ARTERIAL HYPERTENSION (CLINICAL GUIDELINES)].

These clinical guidelines apply to the implementation of health care for all patients with concomitant hypertension in the perioperative period in a hospital. The guidelines specify the method of stratifying the risk of perioperative cardiac complications. We described methods for the treatment of urgent conditions with hypertension and hypertensive crises and identified the main features of the preoperative evaluation and preparation of patients with concomitant hypertension. The clinical guidelines contain recommendations on the management of intra- and postoperative period

[PREEMPTIVE ANALGESIA AS PART OF MULTICOMPONENT ANESTHESIA IN CHILDREN WITH OPERATIONS IN THE NASAL CAVITY AND NASOPHARYNX].

OBJECTIVE: The article presents the results of assessing the impact of pre-emptive analgesia with lidocaine and paracetamol compared withfentanyl for postoperative pain in children undergoing surgery for nasal cavity and nasopharynx. METHODS: We evaluated the incidence and severity ofpostoperative pain in 150 patients aged 3 to 17 years (ASA I-II), following operations in the nasal cavity and nasopharynx. RESULTS: In pre-emptive analgesia group, patients (n = 75) experienced postoperative pain at 28% less in comparison with the control group. The severity ofpain was observed at 50% less in the intervention group which was accompanied by lower levels of cortisol. Additional analgesia during the first 2 hours after surgery there was within 15% less in a pre-emptive analgesia group when compared to the control group. Patients with multi-component of general anesthesia and local anesthetic lidocaine via a nebulizer and paracetamol i. v. were ready for extubation/removal of the laryngeal mask at 40% earlier; andfor transfer to the general department 50% sooner than patient with combined anesthesia with sevoflurane, nitrous oxide and fentanyl.

[Effect of anesthesia in prevention of postoperative nausea and vomiting after surgical interventions in the nasal cavity and nasopharynx in children].

The article deals with results of studying of anesthesia effects on the frequency of postoperative nausea and vomiting during surgical interventions in the nasal cavity and nasopharynx in children. We investigated the incidence of postoperative nausea and vomiting in 100 patients aged 2 to 17 years (ASA I-II), who underwent surgery in the nasal cavity and nasopharynx. The results showed that the anesthesia by sevoflurane with nitrous oxide, local anesthetic lidocaine 4 mg/kg, not more than 200 mg by nebulizer was accompanied by the development of postoperative nausea and vomiting in 4% of cases. In another hand, anesthesia by sevoflurane, nitrous oxide and fentanyl 2-3 mg/kg was accompanied with nausea and vomiting in 18% cases. Analysis of the results showed that the frequency of postoperative nausea and vomiting after anaesthesia without fentanyl by 14% lower than with fentanyl. The nausea and vomiting started within the first hour after surgery in majority number of cases (50-77.7%).

[Therapeutic hypothermia: the potential and prospects].

Hypothermia is a most powerful tool for the protection of various organs especially brain. The review is focused on the mechanisms of protective action (modulation ofmetabolism and local inflammatory reaction, prevention of blood-brain barrier disorders, normalization of nitric oxide synthesis) and technology of therapeutic hypothermia. Main clinical situations in which the most effective and safe application of this technology was achieved are described.

[The support of immune safety of hemotransfusions under implementation of cardiosurgery operations].

The index and structure of allosensibilization of patients according transfusion dangerous antigens of erythrocytes were identified. The purpose of action was to evaluate risk of development of post-transfusion hemolytic complications under application of hemotransfusions during operative interventions on heart and vessels. The immune anti-erythrocytes antibodies were detected in 81 cases (1.7%) and their main percentage formed antibodies of Rhesus system (67.7%). The antibodies to antigens of other systems like anti-K (10%), anti-S (2.5%), anti-Jka (1.2%), anti-Fya (1.2%), anti-Lea (3.7%) were more rarely detected. The estimated index of sensitization in patients made up to 1.7% that testifies higher degree of alloimmunization of examined patients and potential risk of development of post-transfusion complications of hemolytic type under hemotrasfusions. The received data was used as a background to develop and to implement algorithm of immune hematologic examination of patients of cardiosurgery profile. This approach permits minimizing risk of alloimmunization of recipients, to forecast and to prevent development of complications under transfusion of erythrocyte-containing components of donor blood that significantly enhances quality of transfusion therapy.

[Postoperative dynamic changes in matrix metalloproteinase levels in patients with coronary artery bypass graft procedure complications].

The purpose of this study was to evaluate diagnostic and prognostic value of matrix metalloproteinases in postoperative complication development after on-pump coronary artery bypass grafting. 29 coronary artery disease patients who had undergone on-pump coronary artery bypass grafting were examined, 4 of those had complicated systemic inflammatory response and 5 of those had isolated renal failure. Serum matrix metalloproteinase/tissue inhibitor of matrix metalloproteinase concentrations were measured before surgery, at day 1 and day 7 after surgery. Postoperative period was found to be characterized by higher levels of serum matrix metalloproteinases (MMP-9, proMMP-1) and lower levels of matrix metalloproteinase 1 tissue inhibitor. Complicated systemic inflammatory response was associated with higher levels of MMP-9, MMP-3 and proMMP-1, on particular, at day 7.

[Left anterior descending bypass grafting from the anterolateral minitorakotomy].

Current efficient methods of open revascularization in patients with multivessel coronary artery lesions are associated with a certain amount of general and local complications depending on traumatic interventions, bypass, manipulation on the ascending aorta. Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) allows to avoid certain perioperative risk factors and appears to be a promising myocardial revascularization model in isolated lesion of left anterior descending (LAD) and multivessel lesions, applying combines percutaneous intervention (PCI).

[The monitoring of application of dabigatran as a remedy of prevention of thromboembolic complications after hip joint arthroplasty].

The analysis was applied to the indicators of hemostasis system under application of new anticoagulant, dabigatran etexilat, after hip joint arthroplasty. It is established that among the coagulation methods analysis the most specific to the effect of dabigatran is the testing of thrombin and echitox time of coagulation. Considering low sensitivity of the echitox to anticoagulation effect of D-dimer the echitox test is optimal for laboratory monitoring of application of dabigatran after orthopedic intervention.

[Evaluation of the effectiveness and safety of synthetic colloid solutions in the treatment of severe abdominal sepsis: a randomized comparative study].

Infusion therapy, surgical debridement of an infection focus, and antimicrobial therapy are basic treatments for severe sepsis. At the same time there are no uniform guidelines on how to choose fluids for infusion therapy. The results of individual studies serve as the basis for refusing the use of synthetic colloid agents in the therapy of severe sepsis. The presented multicenter, randomized comparative study has evaluated different synthetic colloid solutions in early targeted therapy for severe sepsis. Evidence is provided for the identical effectiveness of the compared solutions in correcting hypovolemia and stabilizing hemodynamics in patients with severe sepsis and septic shock.

[Clinical pathogenetic types of blood-peritoneal barrier damage in abdominal sepsis].

Many authors point to the peritoneum-blood barrier damage factor in the pathogenesis of abdominal sepsis and peritonitis. The study was undertaken to define the types of blood-peritoneal barrier damage, by providing evidence for a differential approach to intensive care. For this, immunochemical permeability markers and the clinical and laboratory criteria for sepsis were studied in 106 patients. The patients with generalized peritonitis from the sepsis group showed a compensated type of barrier damage. Those with septic shock exhibited its decompensated type. The described types may serve as a criterion for the differential correction of intensive care in abdominal sepsis.

Effect of perftoran on macroglobulin content in the plasma and peritoneal exudate of rats with acute exudative inflammation (peritonitis).

The effect of blood substitute perftoran on the content of alpha(1)- and alpha(2)-macroglobulins in the plasma and exudate was studied in rats with acute exudative inflammation. After intravenous injection of perftoran macroglobulin content increased in the plasma, but remained unchanged in the peritoneal fluid.

[Characteristics of certain components of the systemic inflammatory reaction in patients with diffusive peritonitis]. / Kharakteristika nekotorykh komponentov sistemnoi vospalitel'noi reaktsii u bol'nykh s rasprostranennym peritonitom.

The clinical, immunobiochemical and hemostasiological parameters of the systemic inflammatory response (SIR) were studied in 51 patients with diffusive peritonitis. The study showed that lactoferrin, plasminogen/plasmin and alpha 2-macroglobulin can be used, in a set, as informative indices of SIR. A reduced content of lactoferrin, a smaller concentration of proteases inhibitor alpha 2-macroglobulin and a higher relation between plasminogen and plasmin correlate with an unfavorable outcome of the disease beginning from the 1st postoperative day. An activity of Willebrandt's factor is a diagnostic and prognostic marker, which determines a lesion to the endothelium system.